Individual
WILESHA SHANISE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
242 HOLMES DR, SPARTANBURG, SC 29303-4419
(864) 621-1825
Mailing address
242 HOLMES DR, SPARTANBURG, SC 29303-4419
(864) 621-1825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/14/2024
Last updated
04/16/2026
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